A new surgical technique for endothelial keratoplasty is described, in which the composite of pre-Descemet's layer (Dua's layer) with Descemet's membrane and endothelium is transplanted subsequent to the removal of the recipient's Descemet 's membrane. The technique was performed in five eyes of five patients, with successful attachment of the graft and good postoperative visual recovery in all cases. Postoperative optical coherence tomography showed good graft attachment without interface abnormalities and a mean graft thickness was 28±5.6 μm. This study demonstrates the practicality of the technique, termed pre-Descemet's endothelial keratoplasty (PDEK), which can be a viable option in endothelial keratoplasty with some potential advantages.
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